PAH Incidence Rare in France But Carries High Economic Burden, Study Shows

The incidence of pulmonary arterial hypertension (PAH) is rare in France, but it carries a high economic burden, a new study showed.

The data were reported in “Hospital Burden of Pulmonary Arterial Hypertension in France,” a study published in the journal PLOS ONE.

Economic studies on the direct or indirect costs of PAH are scarce, yet this information is critical for the optimal organization and funding of healthcare systems.

Now, researchers in France provide the first available estimate on the costs of hospitalizations associated with PAH — a rare, progressive disorder characterized by high blood pressure in the arteries of the lungs — in the country.

The teams retrospectively analyzed the French medical information PMSI-MSO database. Researchers used a diagnostic algorithm to identify new PAH cases in 2013 and calculate the associated healthcare costs.

A total 384 patients in France, who were hospitalized due to PAH during 2013 — mean age 59.6 years; 62.8% women — were analyzed. During a 12-month period, a total of 1,271 hospital stays for a reason related to PAH were reported in this patient group.

The most frequently documented comorbidities — or other concurrent conditions —were liver diseases (16.1%) and connective tissue diseases (16.1%). A total 31 patients (8.1%) died during hospitalization, and four (1.0%) received a lung/heart-lung transplant.

Based on the timing, duration, and reason, hospital stays during the year following the initial hospitalization were classified as incident stays, monitoring stays, or stays due to disease worsening. The researchers noted that, in the European Union, all individuals with PAH must be hospitalized for monitoring three and 12 months after diagnosis.

For the patients analyzed, 415 incident stays were reported, along with 604 monitoring stays, and 252 worsening stays.

The total annual costs of these PAH hospitalizations was €3,640,382 (about $3.98 million). About 82% of that cost — €2,985,936 or about $3.26 million — was attributable to standard tariffs. The total also included €463,325 (about $506,000) in additional intensive care unit stays, which was about 12.7% of the costs. The remaining 5.2% of costs, totaling €191,118 (about $209,000), paid for expensive therapies.

The mean cost per stay was €2,864 (approximately $3,131). That ranged from €1,282 (about $1,402) for monitoring stays, to €7,285 ($7,965) for worsening stays.

Comparison of these values with those for other chronic cardiovascular or pulmonary disorders, such as chronic obstructive pulmonary disease (COPD) or acute heart failure, revealed that the mean cost per PAH patient was lower. COPD mean costs were €6,000 (about $6,561), while those for acute heart failure were €4,713 (about $5,153).

However, hospital stays for worsening of PAH were more expensive than hospitalizations for exacerbations of COPD or acute heart failure.

“Given the much lower prevalence of PAH than these disorders, the total cost of hospitalisations to the health system (€ 4 million) [$4.37 million] is much lower than in the case of COPD exacerbations (€ 670 million) [$733 million], or AHF [acute heart failure] (€750 million) [$820 million],” the researchers said.

“The total cost of hospitalisation for PAH thus represents around 0.02% of the total cost of all hospitalisations in France,” they added.

Overall, based on the results, the team concluded that “although pulmonary arterial hypertension is rare, it carries a high economic burden” in France.

The researchers also noted that the “cost findings are difficult to compare with those of the North American costing studies due to differences in the organisation and funding of the health system.”